Vitamin D insufficiency is associated with an increased risk of early clinical failure in follicular lymphoma

S. I. Tracy; M. J. Maurer; T. E. Witzig; M. T. Drake; S. M. Ansell; G. S. Nowakowski; C. A. Thompson; D. J. Inwards; P. B. Johnston; I. N. Micallef; C. Allmer; W. R. MacOn; G. J. Weiner; S. L. Slager; T. M. Habermann; B. K. Link; J. R. Cerhan

doi:10.1038/bcj.2017.70

Vitamin D insufficiency is associated with an increased risk of early clinical failure in follicular lymphoma

S. I. Tracy, M. J. Maurer, T. E. Witzig, M. T. Drake, S. M. Ansell, G. S. Nowakowski, C. A. Thompson, D. J. Inwards, P. B. Johnston, I. N. Micallef, C. Allmer, W. R. MacOn, G. J. Weiner, S. L. Slager, T. M. Habermann, B. K. Link, J. R. Cerhan

Medicine - Hematology, Oncology, Transplant

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Abstract

We evaluated whether vitamin D insufficiency (VDI; 25(OH)D <20 ng/ml) was associated with adverse outcomes among follicular lymphoma (FL) patients using an observational prospective cohort study of 642 FL patients enrolled from 2002-2012. The median age at diagnosis was 60 years. At a median follow-up of 59 months, 297 patients (46%) had an event (progression, treatment failure), 78 had died and 42 (6.5%) had a lymphoma-related death. VDI was associated with inferior event-free survival (EFS) at 12 months (EFS12, odds ratio (OR)=2.05; 95% confidence interval (CI) 1.18-3.54), overall survival (OS, hazards ratio (HR)=2.35; 95%CI 1.37-4.02), and lymphoma-specific survival (LSS, HR=2.97; 95% CI 1.52-5.80) for the full cohort. Among patients treated with immunochemotherapy (IC), VDI was associated with inferior EFS12 (OR=3.00; 95% CI 1.26-7.13), OS (HR=2.86; 95% CI 1.39-5.85), and LSS (HR=2.96; 95% CI 1.29-6.79). For observed patients, VDI was associated with inferior OS (HR=2.85; 95% CI 1.20-6.76). For other therapies, VDI was associated with inferior OS (HR=3.06; 95% CI 1.01-9.24). Our work is the first to reveal an association of VDI with early clinical failure, and to demonstrate an association of VDI with adverse outcomes among patients who are observed or treated with therapies other than IC. Our findings suggest a potentially modifiable prognostic factor to address in patients with FL.

Original language	English (US)
Article number	e595
Journal	Blood cancer journal
Volume	7
Issue number	8
DOIs	https://doi.org/10.1038/bcj.2017.70
State	Published - Aug 25 2017

Bibliographical note

Funding Information:
We thank Ms Sondra Buehler for editorial assistance. This work was supported in part by the National Institutes of Health (P50 CA97274) to the University of Iowa/Mayo Clinic Lymphoma Specialized Program of Research Excellence and the Henry J. Predolin Foundation.

Publisher Copyright:
© 2017 The Author(s).

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10.1038/bcj.2017.70

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5596381

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Tracy, S. I., Maurer, M. J., Witzig, T. E., Drake, M. T., Ansell, S. M., Nowakowski, G. S., Thompson, C. A., Inwards, D. J., Johnston, P. B., Micallef, I. N., Allmer, C., MacOn, W. R., Weiner, G. J., Slager, S. L., Habermann, T. M., Link, B. K., & Cerhan, J. R. (2017). Vitamin D insufficiency is associated with an increased risk of early clinical failure in follicular lymphoma. Blood cancer journal, 7(8), [e595]. https://doi.org/10.1038/bcj.2017.70

Tracy, SI, Maurer, MJ, Witzig, TE, Drake, MT, Ansell, SM, Nowakowski, GS, Thompson, CA, Inwards, DJ, Johnston, PB, Micallef, IN, Allmer, C, MacOn, WR, Weiner, GJ, Slager, SL, Habermann, TM, Link, BK & Cerhan, JR 2017, 'Vitamin D insufficiency is associated with an increased risk of early clinical failure in follicular lymphoma', Blood cancer journal, vol. 7, no. 8, e595. https://doi.org/10.1038/bcj.2017.70

@article{44a34028546346f7b5b59a235e6f7468,

title = "Vitamin D insufficiency is associated with an increased risk of early clinical failure in follicular lymphoma",

abstract = "We evaluated whether vitamin D insufficiency (VDI; 25(OH)D <20 ng/ml) was associated with adverse outcomes among follicular lymphoma (FL) patients using an observational prospective cohort study of 642 FL patients enrolled from 2002-2012. The median age at diagnosis was 60 years. At a median follow-up of 59 months, 297 patients (46%) had an event (progression, treatment failure), 78 had died and 42 (6.5%) had a lymphoma-related death. VDI was associated with inferior event-free survival (EFS) at 12 months (EFS12, odds ratio (OR)=2.05; 95% confidence interval (CI) 1.18-3.54), overall survival (OS, hazards ratio (HR)=2.35; 95%CI 1.37-4.02), and lymphoma-specific survival (LSS, HR=2.97; 95% CI 1.52-5.80) for the full cohort. Among patients treated with immunochemotherapy (IC), VDI was associated with inferior EFS12 (OR=3.00; 95% CI 1.26-7.13), OS (HR=2.86; 95% CI 1.39-5.85), and LSS (HR=2.96; 95% CI 1.29-6.79). For observed patients, VDI was associated with inferior OS (HR=2.85; 95% CI 1.20-6.76). For other therapies, VDI was associated with inferior OS (HR=3.06; 95% CI 1.01-9.24). Our work is the first to reveal an association of VDI with early clinical failure, and to demonstrate an association of VDI with adverse outcomes among patients who are observed or treated with therapies other than IC. Our findings suggest a potentially modifiable prognostic factor to address in patients with FL.",

author = "Tracy, {S. I.} and Maurer, {M. J.} and Witzig, {T. E.} and Drake, {M. T.} and Ansell, {S. M.} and Nowakowski, {G. S.} and Thompson, {C. A.} and Inwards, {D. J.} and Johnston, {P. B.} and Micallef, {I. N.} and C. Allmer and MacOn, {W. R.} and Weiner, {G. J.} and Slager, {S. L.} and Habermann, {T. M.} and Link, {B. K.} and Cerhan, {J. R.}",

note = "Funding Information: We thank Ms Sondra Buehler for editorial assistance. This work was supported in part by the National Institutes of Health (P50 CA97274) to the University of Iowa/Mayo Clinic Lymphoma Specialized Program of Research Excellence and the Henry J. Predolin Foundation. Publisher Copyright: {\textcopyright} 2017 The Author(s).",

year = "2017",

month = aug,

day = "25",

doi = "10.1038/bcj.2017.70",

language = "English (US)",

volume = "7",

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T1 - Vitamin D insufficiency is associated with an increased risk of early clinical failure in follicular lymphoma

AU - Tracy, S. I.

AU - Maurer, M. J.

AU - Witzig, T. E.

AU - Drake, M. T.

AU - Ansell, S. M.

AU - Nowakowski, G. S.

AU - Thompson, C. A.

AU - Inwards, D. J.

AU - Johnston, P. B.

AU - Micallef, I. N.

AU - Allmer, C.

AU - MacOn, W. R.

AU - Weiner, G. J.

AU - Slager, S. L.

AU - Habermann, T. M.

AU - Link, B. K.

AU - Cerhan, J. R.

N1 - Funding Information: We thank Ms Sondra Buehler for editorial assistance. This work was supported in part by the National Institutes of Health (P50 CA97274) to the University of Iowa/Mayo Clinic Lymphoma Specialized Program of Research Excellence and the Henry J. Predolin Foundation. Publisher Copyright: © 2017 The Author(s).

PY - 2017/8/25

Y1 - 2017/8/25

N2 - We evaluated whether vitamin D insufficiency (VDI; 25(OH)D <20 ng/ml) was associated with adverse outcomes among follicular lymphoma (FL) patients using an observational prospective cohort study of 642 FL patients enrolled from 2002-2012. The median age at diagnosis was 60 years. At a median follow-up of 59 months, 297 patients (46%) had an event (progression, treatment failure), 78 had died and 42 (6.5%) had a lymphoma-related death. VDI was associated with inferior event-free survival (EFS) at 12 months (EFS12, odds ratio (OR)=2.05; 95% confidence interval (CI) 1.18-3.54), overall survival (OS, hazards ratio (HR)=2.35; 95%CI 1.37-4.02), and lymphoma-specific survival (LSS, HR=2.97; 95% CI 1.52-5.80) for the full cohort. Among patients treated with immunochemotherapy (IC), VDI was associated with inferior EFS12 (OR=3.00; 95% CI 1.26-7.13), OS (HR=2.86; 95% CI 1.39-5.85), and LSS (HR=2.96; 95% CI 1.29-6.79). For observed patients, VDI was associated with inferior OS (HR=2.85; 95% CI 1.20-6.76). For other therapies, VDI was associated with inferior OS (HR=3.06; 95% CI 1.01-9.24). Our work is the first to reveal an association of VDI with early clinical failure, and to demonstrate an association of VDI with adverse outcomes among patients who are observed or treated with therapies other than IC. Our findings suggest a potentially modifiable prognostic factor to address in patients with FL.

AB - We evaluated whether vitamin D insufficiency (VDI; 25(OH)D <20 ng/ml) was associated with adverse outcomes among follicular lymphoma (FL) patients using an observational prospective cohort study of 642 FL patients enrolled from 2002-2012. The median age at diagnosis was 60 years. At a median follow-up of 59 months, 297 patients (46%) had an event (progression, treatment failure), 78 had died and 42 (6.5%) had a lymphoma-related death. VDI was associated with inferior event-free survival (EFS) at 12 months (EFS12, odds ratio (OR)=2.05; 95% confidence interval (CI) 1.18-3.54), overall survival (OS, hazards ratio (HR)=2.35; 95%CI 1.37-4.02), and lymphoma-specific survival (LSS, HR=2.97; 95% CI 1.52-5.80) for the full cohort. Among patients treated with immunochemotherapy (IC), VDI was associated with inferior EFS12 (OR=3.00; 95% CI 1.26-7.13), OS (HR=2.86; 95% CI 1.39-5.85), and LSS (HR=2.96; 95% CI 1.29-6.79). For observed patients, VDI was associated with inferior OS (HR=2.85; 95% CI 1.20-6.76). For other therapies, VDI was associated with inferior OS (HR=3.06; 95% CI 1.01-9.24). Our work is the first to reveal an association of VDI with early clinical failure, and to demonstrate an association of VDI with adverse outcomes among patients who are observed or treated with therapies other than IC. Our findings suggest a potentially modifiable prognostic factor to address in patients with FL.

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Vitamin D insufficiency is associated with an increased risk of early clinical failure in follicular lymphoma

Abstract

Bibliographical note

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